| NPI | 1477544740 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: SC 37748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 2831) |
| 207Q00000X Family Medicine (Licence: SC 37748) | |
| 202K00000X (Licence: OK 2831) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2022-10-18 |