| NPI | 1013351964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2013032509) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 22905) |
| 363A00000X Physician Assistant (Licence: UT 8547052-1206) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2013-12-04 |