| NPI | 1245678457 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T1515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1255) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NE 1255) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX T1515) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2021-05-18 |