| NPI | 1336539295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 08849) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05564) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2018-09-25 |