| NPI | 1578976213 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 94-08289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0068662) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2022-04-21 |