| NPI | 1689626012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1305) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103755) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-05-13 |