| NPI | 1093257099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA OA003989) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA058714) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2016-11-09 |