| NPI | 1801559653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2025039793) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA063280) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2025-10-08 |