| NPI | 1275749053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9107257) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002279) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2013-09-20 |