| NPI | 1700375482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-11442) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2024-12-30 |