| NPI | 1528619111 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001012879) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4606) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2023-03-21 |