| NPI | 1912655390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101281486) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208D00000X General Practice (Licence: VA 0101281486) | |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2025-08-21 |