| NPI | 1972865095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA055541) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055541) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2021-09-29 |