| NPI | 1528461019 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09250) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 9155482-1206) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2021-08-10 |