| NPI | 1538265913 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians (Licence: TX M0715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M0715) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-12-19 |