| NPI | 1508124264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9540057-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9450057-1724) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2022-04-05 |