| NPI | 1053164269 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI MDR-8807) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2025-06-13 |