| NPI | 1083611578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3801) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00036274) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2014-06-18 |