| NPI | 1780077594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101260778) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2025-08-11 |