| NPI | 1740845189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7079) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9117382) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2024-01-19 |