| NPI | 1104808765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M0376) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX M0376) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2022-06-01 |