| NPI | 1609003177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N8980) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012024612) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2016-08-03 |