| NPI | 1831456615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10528) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004278) |
| 363A00000X Physician Assistant (Licence: GA 007461) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2021-09-14 |