| NPI | 1548745417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004944) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060440) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2024-06-11 |