| NPI | 1003220062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA057550) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA PAT0063) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2015-07-02 |