| NPI | 1386115897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019039571) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: OR PA209297) | |
| 363AM0700X Physician Assistant, Medical (Licence: MS 2019039571) | |
| Enumeration Date | 2018-12-09 |
| Last Update Date | 2023-08-28 |