| NPI | 1104866144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 962) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1036) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2016-09-12 |