| NPI | 1104121045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1619) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL1619) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2020-02-10 |