| NPI | 1699965939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7061916-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO152388) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2017-06-22 |