| NPI | 1821073743 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX n0256) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2014-08-01 |