| NPI | 1770743882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TX 111908) |
| Additional Taxonomies | 171W00000X Contractor (Licence: TX 111908) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |