| NPI | 1366199754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO DR.0071968) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2023-10-14 |