| NPI | 1164164828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX V8734) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TX V8734) | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-10-31 |