| NPI | 1104814607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9112874-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 57446) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2021-07-14 |