| NPI | 1407939945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0056210) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD d0056210) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2021-09-21 |