| NPI | 1376535260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 006891) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY 1066586) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2014-02-24 |