| NPI | 1053863803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NC PHYP 7414) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AK PHYP 1761) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2017-02-03 |