| NPI | 1306374780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116030331) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101265465) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2026-07-09 |