| NPI | 1972088938 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08476) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 0010-08476) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2022-01-27 |