| NPI | 1760595011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G6995) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: TX G6955) |
| 207QS0010X Family Medicine Sports Medicine (Licence: TX G6955) | |
| 208D00000X General Practice (Licence: TX G6955) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX G6955) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-06-28 |