| NPI | 1790171643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S4098) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME136662) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2020-03-20 |