| NPI | 1942967294 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA 063183) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA 005930) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2021-11-26 |