| NPI | 1962955690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC PA4658) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06634) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2024-12-09 |