| NPI | 1124388939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q5508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301100345) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2019-03-06 |