| NPI | 1477019784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8405) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9105) |
| 363A00000X Physician Assistant (Licence: SC 3258) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2021-08-05 |