| NPI | 1194023671 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM 2000PA27) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2022-10-04 |