| NPI | 1104697192 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 3003) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 123496) |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-09-20 |