| NPI | 1699775569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L5472) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L5472) |
| 208600000X Surgery (Licence: NC 2008-01191) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2016-07-21 |