| NPI | 1164860268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1825) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 074838) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2015-02-17 |