| NPI | 1952661688 |
|---|---|
| Former Name | AUDREY BLALOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 29248) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 29248) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2017-07-14 |