| NPI | 1497036149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA003411) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056841) |
| 363A00000X Physician Assistant (Licence: MD C0004545) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA056841) | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2021-01-02 |