| NPI | 1265832554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09302) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-09302) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 007268) | |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2024-02-12 |