| NPI | 1225509334 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2020034329) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 6519) |
| 363A00000X Physician Assistant (Licence: CA 55683) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2020-10-14 |