| NPI | 1215441753 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 9110586) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2022-01-27 |