| NPI | 1689201113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2023039436) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001012109) |
| 363AM0700X Physician Assistant, Medical (Licence: NE 2522) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2023-10-24 |