| NPI | 1477526739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101057846) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101057846) |
| 208000000X Pediatrics (Licence: VA 0101057846) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2019-08-06 |