| NPI | 1578184669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 01108065) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA061546) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2024-01-24 |