| NPI | 1164694634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P2852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 8800) |
| 207Q00000X Family Medicine (Licence: AK 6418) | |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2013-05-03 |