| NPI | 1174966774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-38979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0055906) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2018-04-10 |