| NPI | 1104137900 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2496) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1102) |
| 363A00000X Physician Assistant (Licence: IA 002385) | |
| 363AM0700X Physician Assistant, Medical (Licence: IN 10001192A) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2020-07-27 |