| NPI | 1902067242 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06664) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200179) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2022-01-19 |