| NPI | 1639795594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA005236) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA061574) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-09-29 |