| NPI | 1164705513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 6209) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 973) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2015-02-11 |