| NPI | 1053762658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2015001153) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2021-08-04 |