| NPI | 1922691955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10857) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005467) |
| 363A00000X Physician Assistant (Licence: SC 3763) | |
| 363A00000X Physician Assistant (Licence: PA MA062195) | |
| Enumeration Date | 2021-02-20 |
| Last Update Date | 2021-02-20 |