| NPI | 1104177203 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008403) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03819) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2024-02-24 |