| NPI | 1194939199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1154) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01328) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2016-04-22 |