| NPI | 1477066413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6393) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004375) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA059585) | |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2019-06-18 |