| NPI | 1932613551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 008816) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9111016) |
| 363L00000X Nurse Practitioner (Licence: FL Pending) | |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2018-07-16 |