| NPI | 1659776391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7166) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 7166) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2019-04-13 |