| NPI | 1821446071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX R9077) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 30186) |
| Enumeration Date | 2016-05-28 |
| Last Update Date | 2023-11-06 |