| NPI | 1528790128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO DR.0074387) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2025-02-02 |