| NPI | 1760804512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA055811) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004346) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-14034) | |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2024-10-14 |