| NPI | 1174629414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00988) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0110002353) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2022-07-21 |