| NPI | 1710688296 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102208864) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2024-08-30 |