| NPI | 1386029700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 090568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5441) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2019-10-29 |