| NPI | 1053564179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT MT0903117) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2012-09-04 |