| NPI | 1790275477 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0116036829) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116036829) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2024-10-25 |