| NPI | 1568028983 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T9372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.073758) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2022-11-01 |