| NPI | 1740493485 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 626PA) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102665) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-12-15 |