| NPI | 1821618455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME152630) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2024-08-15 |