| NPI | 1629434980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09633) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001954A) |
| Enumeration Date | 2016-01-01 |
| Last Update Date | 2020-01-28 |