| NPI | 1619921640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 5389) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 103814) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2010-02-24 |