| NPI | 1639642051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2022) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PAT-1634) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2023-12-15 |