| NPI | 1275278194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101028588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V0246) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101028588) | |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2025-07-02 |