| NPI | 1053907261 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: PA 7000.000000634RMA) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA 70000634RMA) |
| Enumeration Date | 2020-12-12 |
| Last Update Date | 2020-12-12 |