| NPI | 1396769857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 515) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 02300010101) |
| 363A00000X Physician Assistant (Licence: MN 10210) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-08-30 |