| NPI | 1962892240 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID PA-1557) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA1557) |
| 363A00000X Physician Assistant (Licence: OR PA171318) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2023-11-01 |