| NPI | 1659609766 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T7311) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101243225) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2025-10-13 |