| NPI | 1710038864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 104088) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005517) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2021-02-22 |