| NPI | 1770835340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 20114) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-20114) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2021-12-28 |