| NPI | 1174086102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T6703) |
| Additional Taxonomies | 281P00000X Chronic Disease Hospital (Licence: TX T0703) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-04-28 |