| NPI | 1407133465 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C50000927) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055127) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 2650) | |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2014-06-10 |