| NPI | 1164805420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R9111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2017-0911) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2022-06-09 |