| NPI | 1104809342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 102381) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 600122) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2015-12-10 |