| NPI | 1003409780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4472) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11042) |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2024-05-23 |