| NPI | 1699360511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 011147) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102207417) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2026-04-18 |