| NPI | 1306142336 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05877) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2011002476) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2023-05-15 |