| NPI | 1720469323 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056817) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2019-03-19 |