| NPI | 1407167869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5136) |
| 208D00000X General Practice (Licence: VA 0116022988) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2020-06-22 |