| NPI | 1790169704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA007714) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060912) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2026-06-17 |