| NPI | 1770026270 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1875) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 10166960-1206) |
| 363A00000X Physician Assistant (Licence: UT 10166960-8906) | |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2020-07-07 |