| NPI | 1134305618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063537) |
| Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman (Licence: CA D7433240) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2022-05-31 |