| NPI | 1386880698 |
|---|---|
| Former Name | RENETTA BULLARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 16980) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME 62145) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2015-04-23 |