| NPI | 1801262167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 079375) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09646) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2023-04-27 |