| NPI | 1346650686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2015-01772) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-06-21 |