| NPI | 1619335155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3590) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005188) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2021-01-22 |