| NPI | 1679279657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065931) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE011728) |
| 363A00000X Physician Assistant (Licence: PA OA006998) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA065931) | |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2024-09-27 |