| NPI | 1003057621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02288) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1397) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2016-12-16 |