| NPI | 1356080618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102208259) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0102208259) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2025-07-23 |