| NPI | 1174159669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101272954) |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2024-11-13 |