| NPI | 1407501711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0101279340) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101279340) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2025-08-05 |