| NPI | 1497349211 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TX U1261) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX U1261) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2023-08-31 |