| NPI | 1205302072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3304) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: SC PA3304) |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2022-03-29 |