| NPI | 1154066421 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO DR0071605) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CO DR0071605) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2023-08-17 |