| NPI | 1942970231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11818) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: PA MA062992) | |
| 363A00000X Physician Assistant (Licence: PA OA005859) | |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2022-05-14 |