| NPI | 1720571094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205828) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102205828) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2026-08-10 |