| NPI | 1871915454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T5588) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 1871915454) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2022-09-14 |