| NPI | 1750355293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 101915) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 101915) |
| 363AM0700X Physician Assistant Medical (Licence: NC NC 101915) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2022-07-21 |