| NPI | 1518626894 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM1103X Clinic/Center, Military Ambulatory Procedure Visits Operational (Transportable) (Licence: FL W4261778740) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2021-12-14 |