| NPI | 1972162097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 4949) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA060696) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2022-06-16 |