| NPI | 1629661376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 325945) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA 1179801) |
| Enumeration Date | 2021-02-13 |
| Last Update Date | 2023-03-14 |