| NPI | 1841645298 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60876064) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 32526) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2022-01-28 |