| NPI | 1609837814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103380) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1109) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 103380) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-10-08 |