| NPI | 1407098189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 006851) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01302) |
| 363A00000X Physician Assistant (Licence: TN 1770) | |
| 363A00000X Physician Assistant (Licence: MN 10906) | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2014-09-23 |