| NPI | 1023809811 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2025016545) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MO 2025016545) |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-05-14 |