| NPI | 1871155622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351045569) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T3925) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-12-03 |