| NPI | 1255783312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 302859) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00560) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2023-01-04 |