| NPI | 1497383343 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T9186) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX T9186) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-07-17 |