| NPI | 1548825698 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V8651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 318513) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2026-01-23 |