| NPI | 1184379828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102208040) |
| 208000000X Pediatrics (Licence: VA 0102208040) | |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2024-11-17 |