| NPI | 1750322921 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA052111) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MX003771) |
| 363A00000X Physician Assistant (Licence: PA OA000385L) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-07-21 |