| NPI | 1669092300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9876) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 3555) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2020-10-10 |