| NPI | 1992265425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 87762) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA 87762) |
| 207Q00000X Family Medicine (Licence: NC 0) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-08-09 |