| NPI | 1053591131 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021022669) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 247200000X Technician, Other | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2021-11-19 |