| NPI | 1063862902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08901) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-08901) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA058328) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2023-11-22 |