| NPI | 1407596265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W7729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.081522) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-08-27 |