| NPI | 1629590583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2783) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC TL2783) |
| 363AM0700X Physician Assistant, Medical (Licence: SC MPA2783TL) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2021-11-24 |