| NPI | 1770822074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1169) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA209074) |
| 363A00000X Physician Assistant (Licence: WY TL559) | |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2024-01-30 |