| NPI | 1932320983 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.205176) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.205176) |
| 208000000X Pediatrics (Licence: NC 2007-00351) | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: LA MD205176) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-10-15 |