| NPI | 1659151520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009703) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9117802) |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2024-02-07 |