| NPI | 1124368519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA056014) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA003009) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2019-06-26 |