| NPI | 1174519003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: IA 001913) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IA 002050) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2011-11-30 |