| NPI | 1942704713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TX S3013) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX S3013) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-01-21 |