| NPI | 1780638643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1852) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102604) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-06-04 |