| NPI | 1407302060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058391) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003860) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2019-12-01 |