| NPI | 1104074871 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053531) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA002306) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2021-04-15 |