| NPI | 1679967749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11902) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC PA2325) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2022-02-02 |