| NPI | 1396891511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX P9853) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101240228) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-09-28 |