| NPI | 1548857295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 12206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.1690) |
| 363A00000X Physician Assistant (Licence: TX PA14169) | |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2024-09-02 |