| NPI | 1457633307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 7932) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04394) |
| 363AM0700X Physician Assistant, Medical (Licence: SC 1715) | |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2019-11-06 |