| NPI | 1366682056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003010) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 001001659) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2012-02-23 |