| NPI | 1104439181 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9114464) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007277) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2023-08-09 |