| NPI | 1659807477 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| 302R00000X Health Maintenance Organization | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |