| NPI | 1992346993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021029347) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA063850) |
| 363A00000X Physician Assistant (Licence: WI 5470) | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-06-07 |