| NPI | 1104014679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053973) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2404) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2016-11-04 |