| NPI | 1740879220 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2103) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA228669) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2026-01-15 |