| NPI | 1689042996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057783) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057783) |
| 363A00000X Physician Assistant (Licence: PA OA003612) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2021-12-01 |