| NPI | 1073956900 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06969) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 6727) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110005070) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2017-04-21 |