| NPI | 1396200754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2312) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 094590) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2019-04-02 |