| NPI | 1104067479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NV 1218) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9101832) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2017-01-23 |