| NPI | 1164203030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA 1211175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 1211175) |
| 363A00000X Physician Assistant (Licence: PA 1211175) | |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2023-10-09 |