| NPI | 1407211980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0005983) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: DC PA031208) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2018-03-22 |