| NPI | 1710969720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J0230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 34516) |
| 207Q00000X Family Medicine (Licence: PA MD466641) | |
| 207Q00000X Family Medicine (Licence: LA 312449) | |
| 207Q00000X Family Medicine (Licence: OR MD190989) | |
| 207Q00000X Family Medicine (Licence: NM MD2019-0458) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2019-12-05 |