| NPI | 1255712899 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 200812) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 1255712899) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2017-04-25 |