| NPI | 1154387512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA000703) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA050866) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |