| NPI | 1063629384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051313) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MAO51313) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-04-16 |