| NPI | 1053497396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA2635) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052631) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2016-06-28 |