| NPI | 1679122642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 3765) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2023-01-06 |