| NPI | 1861656464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07333) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2252) |
| 363AM0700X Physician Assistant, Medical (Licence: OR PA150632) | |
| Enumeration Date | 2008-07-12 |
| Last Update Date | 2022-01-07 |