| NPI | 1164968111 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06971) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2670) |
| Enumeration Date | 2017-01-15 |
| Last Update Date | 2017-01-16 |