| NPI | 1669917456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1622) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 10197766-1206) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2022-09-22 |