| NPI | 1164990602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9115838) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA PA6725) |
| 363AS0400X Physician Assistant Surgical (Licence: MA PA6725) | |
| 363A00000X Physician Assistant (Licence: MA PA6725) | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2022-09-27 |