| NPI | 1740520543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208800000X Urology (Licence: WV 3796) |
| 2088P0231X (Licence: SC 89535) | |
| 208D00000X General Practice (Licence: NE 1260) | |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2024-04-24 |