| NPI | 1104348879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8318543-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 8318543-4405) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2021-07-12 |