| NPI | 1013442417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6112) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2020-10-13 |