| NPI | 1205458593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3948) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-10889) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2021-08-18 |