| NPI | 1033193404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 00909) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 000909) |
| 363A00000X Physician Assistant (Licence: WI 292623) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2015-09-28 |