| NPI | 1194759563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02005) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 1483) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2011-04-22 |