| NPI | 1801159488 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT024084) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2025-05-14 |