| NPI | 1811124514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8352718-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 255966) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2021-10-28 |