| NPI | 1972784114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9235) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 246267) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2017-01-20 |