| NPI | 1679057525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004597) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060074) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2020-09-30 |