| NPI | 1962769588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P8733) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10043367) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2020-04-16 |