| NPI | 1801264320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3174) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 116467) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2023-05-04 |