| NPI | 1730472499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q0173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301098588) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2026-09-14 |