| NPI | 1003837493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001001117) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3204) |
| 363AM0700X Physician Assistant, Medical (Licence: AK PAD T 2280) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-09-12 |