| NPI | 1972876738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5094) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2012003986) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2024-01-23 |