| NPI | 1619131034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1038) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA mt192761) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2017-03-29 |