| NPI | 1063954501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OA003971) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2020-09-04 |