| NPI | 1104596980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13902) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4085) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2024-12-13 |