| NPI | 1851794614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 008630) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05235) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05235) | |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2018-03-17 |