| NPI | 1689323388 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1194800) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: 1194800) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2022-06-09 |