| NPI | 1093979395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 51402) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO 51402) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2016-06-04 |