| NPI | 1609925205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005514) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AM0700X Physician Assistant, Medical (Licence: GA 005514) | |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 005514) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2015-02-25 |