| NPI | 1134714629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102207373) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2024-06-25 |