| NPI | 1144361031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 72279) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2019-11-22 |