| NPI | 1902232317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA006500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA002760-L) |
| 363AM0700X Physician Assistant, Medical (Licence: PA OA006500) | |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2023-08-17 |