| NPI | 1053502666 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 6060) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2372) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2015-01-19 |