| NPI | 1063048767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101274782) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2023-08-07 |