| NPI | 1124396692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C04654) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003736) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2016-07-21 |