| NPI | 1104291533 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TN 2879) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AL 1087) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |