| NPI | 1528681863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0102206799) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102206799) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2025-10-03 |