| NPI | 1053311084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA421) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA00840) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2011-02-16 |