| NPI | 1144619776 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09007) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5229) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2023-12-05 |