| NPI | 1073789798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 1068918) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-00310) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2018-08-15 |