| NPI | 1962619742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA053953) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CO 2185) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-04-04 |