| NPI | 1639306947 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO 49242) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CO 49242) |
| 207V00000X Obstetrics & Gynecology (Licence: CO 49242) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2023-08-17 |