| NPI | 1689207011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2463) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 100383) |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-12-31 |