| NPI | 1073923140 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00415) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA.200697) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2019-05-06 |