| NPI | 1447989306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2024012039) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2024-11-13 |