| NPI | 1245531185 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003889) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL1593) |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2014-02-19 |