| NPI | 1942614607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 307587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 307587) |
| 363AM0700X Physician Assistant, Medical (Licence: SC PA2122) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2021-04-20 |