| NPI | 1073624508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05754) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0003296) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-08-26 |