| NPI | 1801650304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.154539) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-08-22 |