| NPI | 1376705376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25440) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: FL 25440) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 25440) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NE 25440) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2023-09-06 |