| NPI | 1750474300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-743) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 13359223-1206) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-09-25 |