| NPI | 1962750216 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8731) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04553) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-04553) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2022-05-22 |