| NPI | 1811941149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 31055) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2005-0767) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2015-06-12 |