| NPI | 1124652375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 8571) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2020008442) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2022-02-09 |