| NPI | 1104897248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2012-0047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23586) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-11-01 |