| NPI | 1912559808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004896) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA060834) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2022-01-19 |