| NPI | 1508560715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101283040) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101283040) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2026-07-23 |