| NPI | 1972647501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057422) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: 1012641) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2022-05-13 |