| NPI | 1710036652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 82134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K8908) |
| 207Q00000X Family Medicine (Licence: LA 205424) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-05-05 |