| NPI | 1194115089 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA004218) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057448) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2017-08-24 |