| NPI | 1790222636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101265175) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101265175) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2024-09-05 |