| NPI | 1982069456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL 1520) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2811) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2020-03-31 |