| NPI | 1164524211 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 3660) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 001536) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2014-11-19 |