| NPI | 1134120413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 102401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 102401) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2019-10-30 |