| NPI | 1053696393 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055266) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA002757) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2020-12-24 |