| NPI | 1053941591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 111067) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 2630) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2024-03-13 |