| NPI | 1912126913 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M9397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301082355) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-07-19 |