| NPI | 1376820670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 008638) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06283) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2018-01-19 |