| NPI | 1669941670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10656) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA64233) |
| 363A00000X Physician Assistant (Licence: FL TPPA641) | |
| 363A00000X Physician Assistant (Licence: UT 13550379-1206) | |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0007023) | |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2024-07-04 |