| NPI | 1619607066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: OH 35.149194) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.253672) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-09-26 |