| NPI | 1639822539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5738-23) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WI 5738-23) |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2022-03-29 |