| NPI | 1700256260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA059512) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA.200888) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2023-03-07 |