| NPI | 1104116664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1639) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC TL1639) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2018-09-20 |