| NPI | 1467291179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL 9119597) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CT 6673) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2025-02-20 |