| NPI | 1639567118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 9225187-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-1481) |
| 363A00000X Physician Assistant (Licence: ND PAC0938) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA53588) | |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2024-05-16 |