| NPI | 1699890715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102895) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1021) |
| 363A00000X Physician Assistant (Licence: GA 006559) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2024-11-13 |