| NPI | 1912338807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001004621) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04621) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2022-03-31 |