| NPI | 1720678840 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA005523) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA062288) |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2021-04-22 |