| NPI | 1770995631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 28771) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207Q00000X Family Medicine (Licence: CA A147820) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2024-04-26 |