| NPI | 1104611474 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX BP10093625) |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2026-05-21 |