| NPI | 1992198980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11143) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05614) |
| Enumeration Date | 2015-03-15 |
| Last Update Date | 2023-01-31 |