| NPI | 1861105116 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: CA 199053) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2024-09-16 |