| NPI | 1023505815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2658) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 110881) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2021-10-21 |