| NPI | 1609869197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 002158) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 002158) |
| 363AS0400X Physician Assistant Surgical (Licence: GA 002158) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2020-04-13 |