| NPI | 1659754554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2820) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058189) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2022-01-04 |