| NPI | 1962642868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 018625) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5362) |
| 363A00000X Physician Assistant (Licence: NC 0010-06056) | |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2022-04-12 |