| NPI | 1073809794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9190) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BPI0040279) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2021-04-13 |