| NPI | 1992001861 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL 9107337) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 2643-023) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2024-02-08 |