| NPI | 1639465065 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.208257) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX P9640) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2023-06-24 |