| NPI | 1104285865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2002) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 081276) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-09-21 |