| NPI | 1629321468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9656) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03812) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2020-03-17 |