| NPI | 1215039649 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 104092) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 1002) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2017-01-06 |