| NPI | 1164613352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX N5234) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX N5234) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2020-05-19 |