| NPI | 1295100493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA058021) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: DE C5-0001284) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2021-06-21 |