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 |