| NPI | 1235366725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: IA 073895) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: PA OA002458) | |
| 363A00000X Physician Assistant (Licence: PA MA054340) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2022-07-21 |