| NPI | 1629266309 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11753) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 4177) |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA1066) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2022-12-13 |