| NPI | 1871181685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA 61582406) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2024-10-16 |