| NPI | 1235480005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3943) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: SD 0900) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2022-08-10 |