| NPI | 1760780803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 363A00000X) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 1620) |
| Enumeration Date | 2011-03-13 |
| Last Update Date | 2024-11-01 |