| NPI | 1578550539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J9262) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: TX J6292) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2009-10-30 |