| NPI | 1831176635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F9485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60340257) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2015-05-12 |