| NPI | 1043761091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10929) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA058662) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2023-01-22 |