| NPI | 1912248733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9205) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: GA 01001035) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2019-03-21 |