| NPI | 1720645799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 56676) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10066663) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-08-04 |