| NPI | 1962082784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V3122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 16118A) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2025-10-13 |