| NPI | 1508354820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019043340) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2022-08-16 |