| NPI | 1902160930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3565) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103689) |
| 363AM0700X Physician Assistant Medical (Licence: VA 0110003919) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2021-10-20 |