| NPI | 1053795120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08006) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6094) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2022-11-09 |