| NPI | 1235874223 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101279631) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2025-09-15 |