| NPI | 1255682589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004858) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004018) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2012-09-26 |