| NPI | 1891567640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: WI 498365) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX 17370) |
| Enumeration Date | 2023-10-25 |
| Last Update Date | 2023-10-25 |