| NPI | 1740682590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3515) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007407) |
| 363A00000X Physician Assistant (Licence: WV 01829) | |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2021-06-30 |