| NPI | 1164761706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2295) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016355) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2013-12-03 |