| NPI | 1720416563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SD 0883) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NE 1778) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 002409) | |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2018-08-02 |