| NPI | 1679219794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101279637) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2024-09-01 |