| NPI | 1639534142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10397) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059223) |
| 363A00000X Physician Assistant (Licence: NC 0010-09396) | |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2022-11-15 |