| NPI | 1689078776 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA060480) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05311) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05311) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2020-04-07 |