| NPI | 1215952239 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA2149) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA AP2149) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-06-23 |