| NPI | 1174504609 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04355) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA2320) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2013-11-13 |