| NPI | 1629122817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 101381) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 101381) |
| 363AM0700X Physician Assistant Medical (Licence: NC 101381) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2025-01-12 |