| NPI | 1205460862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 111257) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 1429) |
| Enumeration Date | 2020-02-23 |
| Last Update Date | 2023-05-09 |