| NPI | 1780940080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06509) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 002742) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2025-10-02 |