| NPI | 1629029202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 38925-021) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WI 38925-21) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-10-25 |