| NPI | 1063452209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-00381) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110001213) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2007-07-08 |