| NPI | 1912143413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 176434) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0699) |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2021-10-19 |