| NPI | 1295122620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004905) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0110004905) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2024-04-02 |