| NPI | 1174944755 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2904) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04629) |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2018-03-17 |