| NPI | 1043581499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C04933) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055381) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA055381) | |
| Enumeration Date | 2012-01-17 |
| Last Update Date | 2012-10-25 |