| NPI | 1104531342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008766) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD C0008766) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2023-01-23 |