| NPI | 1306848056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2007-00319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 21085) |
| 207Q00000X Family Medicine (Licence: TX N7941) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2025-08-18 |