| NPI | 1508221086 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA9113527) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058009) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2021-10-14 |