| NPI | 1659846459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 11469239-1206) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2022-04-28 |