| NPI | 1851642250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA-TF-0126) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002783) |
| 363A00000X Physician Assistant (Licence: WA PA60953850) | |
| 363A00000X Physician Assistant (Licence: ID PA-1766) | |
| 363AM0700X Physician Assistant, Medical (Licence: CT 002783) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 002783) | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2020-08-10 |