| NPI | 1336176510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA193225) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 160) |
| 363A00000X Physician Assistant (Licence: NC 101247) | |
| 363AM0700X Physician Assistant, Medical (Licence: NC 101247) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-01-23 |