| NPI | 1598153256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10425394-8906) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055.0031237) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2021-11-02 |