| NPI | 1598496754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA006113) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA063609) | |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2022-09-14 |