| NPI | 1770877656 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP1-0039555) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2017-04-28 |