| NPI | 1598262644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101268753) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101268753) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2022-03-23 |