| NPI | 1811600596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601011451) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-12-28 |
| Last Update Date | 2023-12-14 |