| NPI | 1750339099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7012) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.003062) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 1110) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-03-15 |