| NPI | 1730558172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9115156) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057844) |
| 363AM0700X Physician Assistant, Medical (Licence: CO 4603) | |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2023-02-27 |