| NPI | 1629715552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0101280042) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101280042) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2024-05-28 |