| NPI | 1285633941 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 101536) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 003223) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2011-02-09 |