| NPI | 1053351411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-263) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 263) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-02-24 |