| NPI | 1972264711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001012514) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2025-08-29 |