| NPI | 1154322733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 29909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 632) |
| 207Q00000X Family Medicine (Licence: KS 05-23055) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2009-08-17 |