| NPI | 1245564129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09097) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5599) |
| 363A00000X Physician Assistant (Licence: VA 0110003110) | |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2020-04-28 |