| NPI | 1790151165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05903) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05903) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05903) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2019-12-23 |