| NPI | 1457635732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA192419) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055.0031167) |
| 363A00000X Physician Assistant (Licence: NC 0010-08485) | |
| 363AM0700X Physician Assistant Medical (Licence: SC TL1722) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2023-07-14 |