| NPI | 1215563473 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NE 34139) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 34139) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2023-08-15 |