| NPI | 1063143626 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12331) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 1193556) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2024-01-09 |