| NPI | 1124084322 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 006154) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2006028767) |
| 363A00000X Physician Assistant (Licence: MA 2063) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2022-01-13 |