| NPI | 1407960768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 104215) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 911) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2014-02-24 |