| NPI | 1720582448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: CO DR.0063023) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CO DR.0063023) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2023-09-21 |