| NPI | 1629623624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V2176) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.44762) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2025-12-19 |