| NPI | 1205114592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1600) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002334) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2015-06-03 |