| NPI | 1528452208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2024-10-15 |