| NPI | 1144294760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 24850) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AL 00024850) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2025-08-19 |