| NPI | 1609225952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA 151175) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2023-12-18 |