| NPI | 1104051150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0009864) |
| Additional Taxonomies | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2025-05-14 |