| NPI | 1992265425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: GA 87762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 0) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2022-07-21 |