| NPI | 1972167260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 9833) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 9833) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2022-05-11 |