| NPI | 1619692506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA064444) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD pending) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2023-06-13 |