| NPI | 1720740665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 5601011257) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601011257) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2024-01-12 |