| NPI | 1326386996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S1268) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101252936) |
| 174400000X Specialist (Licence: FL ME 114649) | |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2020-05-06 |