| NPI | 1629340518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 134971) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 41197) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2018-11-02 |