| NPI | 1548600406 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17572) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102203935) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2025-10-29 |