| NPI | 1205186319 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC TL1821) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001004961) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2015-10-15 |