| NPI | 1407129414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002267A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04175) |
| 363A00000X Physician Assistant (Licence: AL 789) | |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2020-06-23 |