| NPI | 1356651889 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK PADA1191) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006030) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2018-03-17 |