| NPI | 1205235611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9355) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5022) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2019-09-06 |