| NPI | 1205085859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 300208) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005417) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2017-04-13 |