| NPI | 1073718789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N2755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01063435A) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2022-05-06 |