| NPI | 1265684732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104824) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA 60055265) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2019-03-13 |