| NPI | 1679772354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10956) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9104986) |
| 363AM0700X Physician Assistant Medical (Licence: NY 011901) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2023-10-19 |