| NPI | 1629761390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2025-00024) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2025-04-24 |