| NPI | 1740889203 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-10293) |
| Enumeration Date | 2020-10-25 |
| Last Update Date | 2022-07-16 |