| NPI | 1053695668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00286) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.780) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2022-05-02 |