| NPI | 1205465929 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101273254) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2025-08-04 |