| NPI | 1841804622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001010473) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-10473) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2020-09-17 |