| NPI | 1063054039 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2023011685) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SD 1221) |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2023-07-24 |