| NPI | 1063453629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9109368) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA052381) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2016-05-12 |