| NPI | 1093202616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T7003) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX T7003) | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2026-05-19 |