| NPI | 1184804650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008169) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA52681) |
| 363A00000X Physician Assistant (Licence: VA 0110008203) | |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601005170) | |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2024-01-10 |