| NPI | 1619333440 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058043) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003722) |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2021-08-13 |