| NPI | 1962119503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA064059) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-14619) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2024-10-08 |