| NPI | 1073154647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009312) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363A00000X Physician Assistant (Licence: OK 4532) | |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2023-08-01 |