| NPI | 1962653865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061423) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0003817) | |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2021-06-14 |