| NPI | 1164883575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6422) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1116) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2021-10-29 |