| NPI | 1750921086 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 099577) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IA 099577) |
| 363AS0400X Physician Assistant Surgical (Licence: IA 099577) | |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2021-07-28 |