| NPI | 1053983445 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13662) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062607) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2025-09-23 |