| NPI | 1396161550 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NC 0010-04874) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04874) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2025-08-12 |