| NPI | 1891279154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2309) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-006387) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2022-08-18 |