| NPI | 1578524443 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60516173) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA MD065690L) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2016-01-18 |