| NPI | 1588256572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1178756) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2023-02-27 |