| NPI | 1629374814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021011609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6890) |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2021-11-30 |