| NPI | 1376698688 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00697) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002537) |
| 363A00000X Physician Assistant (Licence: OH 003803) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-12-09 |