| NPI | 1063038305 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA061607) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005266) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-07-15 |