| NPI | 1124640164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 34553) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2023-07-18 |