| NPI | 1114911161 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M4578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 5657) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2017-01-13 |