| NPI | 1801383971 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205820) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 102205820) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2025-09-05 |