| NPI | 1811329493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX TX0124) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 020996) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2022-07-21 |