| NPI | 1952395758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MT MED-PAC-LIC-355) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 355) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2021-12-14 |