| NPI | 1801411715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9856) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY 1172186) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-10-01 |