| NPI | 1518360973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 011006326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA1494) |
| 363A00000X Physician Assistant (Licence: SC PA2588) | |
| 363A00000X Physician Assistant (Licence: FL PA9108162) | |
| 363A00000X Physician Assistant (Licence: GA PA8247) | |
| 363A00000X Physician Assistant (Licence: CA PA54126) | |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2019-09-11 |