| NPI | 1407970122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 006106) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0110001862) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2014-11-25 |