| NPI | 1679696611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 17202) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G5030) |
| 207Q00000X Family Medicine (Licence: OK 14875) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NE 17202) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX G5030) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OK 14875) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |