| NPI | 1174073902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11619) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058572) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2023-06-13 |