| NPI | 1114102480 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003355) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL PA546) |
| 363A00000X Physician Assistant (Licence: AL 546) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2019-01-30 |