| NPI | 1801933015 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: WA 5954) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AZ 5984) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2008-04-20 |