| NPI | 1447012893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102209581) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2025-08-21 |