| NPI | 1992355648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-09286) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8914) |
| 363A00000X Physician Assistant (Licence: NC 0010-09286) | |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2024-12-05 |