| NPI | 1568017911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09510) |
| 363A00000X Physician Assistant (Licence: SC 3819) | |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2024-01-16 |