| NPI | 1205366531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 208598) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 8608) |
| 363AM0700X Physician Assistant, Medical (Licence: SC PA2754) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-10-04 |