| NPI | 1780628446 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11899) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055258) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-01-17 |