| NPI | 1861922197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R5692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO4806) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2020-11-06 |