| NPI | 1891770541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004811) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA003037L) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-10-07 |