| NPI | 1255682647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5255) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 5255) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2019-03-21 |