| NPI | 1073793618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002255) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3729) |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2012-05-17 |