| NPI | 1649708629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101280573) |
| 208D00000X General Practice (Licence: CO DR.0061390) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2024-03-05 |