| NPI | 1154076834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101280705) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2026-05-18 |