| NPI | 1710988415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J2254) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: GA 104210) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2025-08-05 |