| NPI | 1295712990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09861) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1729) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2020-11-25 |