| NPI | 1831664846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA006175) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060217) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA060217) | |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2022-08-17 |