| NPI | 1194102327 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06413) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057486) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2019-05-03 |