| 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 |