| NPI | 1659025138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 202302144) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2025-06-24 |