| NPI | 1063623080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101015799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N4666) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2016-11-16 |