| NPI | 1902422967 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 36219) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 36219) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-08-23 |