| NPI | 1679968911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07584) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001794A) |
| 363AM0700X Physician Assistant Medical (Licence: IN 10001794A) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2023-02-15 |