| NPI | 1689338188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 1053590) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2022-06-13 |