| NPI | 1861669814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5002) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20096) |
| 363A00000X Physician Assistant (Licence: TX PA05684) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2020-11-05 |