| NPI | 1669706768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05594) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 5704) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106724) | |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 5704) | |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2021-04-01 |