| NPI | 1033170964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MT 60020) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 1021) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2018-03-17 |