| NPI | 1770012643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 67015) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6092) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2021-07-26 |