| NPI | 1033746508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2025-03603) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208800000X Urology (Licence: VA 0102206875) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-12-23 |