| NPI | 1013649318 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 1013649318) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2023-06-21 |