| NPI | 1255627196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID 3261975) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054911) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2025-03-27 |