| NPI | 1821546383 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10077562-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MT MED-PAC-LIC-59078) |
| 363AM0700X Physician Assistant Medical (Licence: WA PA61053866) | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2023-06-08 |