| NPI | 1972941052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 075444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10045431) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2024-10-22 |