| NPI | 1053564815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1736) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MS PA00113) |
| 363A00000X Physician Assistant (Licence: AK 2056) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2016-07-23 |