| NPI | 1154625887 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2011025918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10033051) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2017-03-14 |