| NPI | 1053700450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA003504) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057351) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2022-06-09 |