| NPI | 1881973766 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2485) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1165-226) |
| 363A00000X Physician Assistant (Licence: IA 092705) | |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2022-03-30 |