| NPI | 1194133538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1920) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GU PA-102) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2021-11-11 |