| NPI | 1740249150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1917) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 000103903) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-05-20 |