| NPI | 1972244408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10078452) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX W0969) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-12-09 |