| NPI | 1609322197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 9204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9109650) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 9204) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2023-08-22 |