| NPI | 1821612391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2023046479) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 028957) |
| 363A00000X Physician Assistant (Licence: IN 10002971A) | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2024-02-13 |