| NPI | 1174850713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01932) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-01932) |
| 363AM0700X Physician Assistant, Medical (Licence: SC PA 1591) | |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2021-04-11 |