| NPI | 1245285782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 5770) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L5770) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2017-11-07 |