| NPI | 1376116376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 4612) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2025-02-07 |