| NPI | 1760436851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9592) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA002174L) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA002174L) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C0001778) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2020-08-14 |