| NPI | 1265787774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2159) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058810) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2018-03-17 |