| NPI | 1104991777 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OA002592) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2011-04-06 |