| NPI | 1912448788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101265298) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2024-07-02 |