| NPI | 1154725273 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S5896) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18860) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2020-09-15 |