| NPI | 1720610058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V4135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD482669) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2026-06-18 |