| NPI | 1215591219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4092) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9279) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2022-01-20 |