| NPI | 1124035324 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: TX 751968945) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: TX 751968945) |
| 302R00000X Health Maintenance Organization (Licence: TX 751968945) | |
| 305R00000X Preferred Provider Organization (Licence: TX 751968945) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2025-09-11 |