| NPI | 1598243719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 3014) |
| 363AM0700X Physician Assistant, Medical (Licence: SC 3014) | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2022-03-23 |