| NPI | 1124111083 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2676) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001172) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2017-11-08 |