| NPI | 1962631564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01832) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-1832) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2023-09-28 |