| NPI | 1770850190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: GA 2222) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4344) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2018-11-28 |