| NPI | 1205216157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 34074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08605) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2018-09-21 |