| NPI | 1154586790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 55644-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N2910) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2022-07-21 |