| NPI | 1720190127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 098740) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9101709) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9101709) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-11-19 |