| NPI | 1871861005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MT MT-MED-PAC-LIC-62752) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2021-03-03 |