| NPI | 1972856219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10773) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106782) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2022-02-17 |