| NPI | 1902663404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: ID 3571290) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2026-04-06 |