| NPI | 1205135456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-938) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2011-03-26 |
| Last Update Date | 2022-03-08 |