| NPI | 1720408727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.305577) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2021-01-08 |