| NPI | 1750529764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: GA 007386) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-03360) |
| 363AM0700X Physician Assistant Medical (Licence: MI 5601005386) | |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2022-05-18 |