| NPI | 1508581463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2022-10-04 |