| NPI | 1679102412 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V6592) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 313979) | 
| Enumeration Date | 2020-04-03 | 
| Last Update Date | 2025-04-01 |