| NPI | 1811431208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0011673) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020435) |
| 363A00000X Physician Assistant (Licence: MD C08263) | |
| 363A00000X Physician Assistant (Licence: GA 9227) | |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2022-02-02 |