| NPI | 1164161972 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD 1164161972) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD 1164161972) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2025-08-13 |