| NPI | 1578105664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001015437) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060967) |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2025-11-21 |