| NPI | 1104135326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7766525-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-1182) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2024-10-21 |