| NPI | 1841858784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX V6687) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208D00000X General Practice (Licence: NE 2290) | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-05-15 |