| NPI | 1376946897 |
|---|---|
| Former Name | LYDIA KAY WILLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2019-08-16 |