| NPI | 1306823505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101015834) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2018-06-12 |