| NPI | 1669472551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 6565) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00745) |
| 363AM0700X Physician Assistant, Medical (Licence: WI 1775-023) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2016-09-02 |