| NPI | 1427574235 |
|---|---|
| Former Name | MARISSA GONZALEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2022-04-12 |