| NPI | 1083120273 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2023015103) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10002415A) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA061603) | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2023-11-03 |