| NPI | 1073212635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13084) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC 001013084) |
| 363AM0700X Physician Assistant Medical (Licence: NC 001-13084) | |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2023-12-04 |