| NPI | 1972167237 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101281039) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2024-10-02 |