| NPI | 1790755601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103295) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 103295) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-08-21 |