| NPI | 1780065342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10051981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 31477) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2019-11-12 |