| NPI | 1770207540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12747) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2022-12-08 |