| NPI | 1538135157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0110001767) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110001767) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2018-06-29 |