| NPI | 1215274451 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SD 0845) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NE 1760) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2016-06-02 |