| NPI | 1104968684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6649) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 25221) |
| 207Q00000X Family Medicine (Licence: OK 25221) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2011-09-13 |