| NPI | 1730651704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-09926) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09926) |
| 363A00000X Physician Assistant (Licence: MD C07096) | |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0007096) | |
| 363AM0700X Physician Assistant, Medical (Licence: NC 09926) | |
| Enumeration Date | 2019-01-01 |
| Last Update Date | 2022-11-02 |