| NPI | 1962755744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 35222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6724) |
| 207Q00000X Family Medicine (Licence: NE 28932) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2021-10-29 |