| NPI | 1700312972 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101265320) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101265320) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2024-07-09 |