| NPI | 1710524749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA005107) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA061283) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2022-02-09 |