| NPI | 1568991446 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205476) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2020-07-21 |