| NPI | 1922247345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA8833) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5526) |
| 363A00000X Physician Assistant (Licence: VA 0110006747) | |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2022-11-02 |