| NPI | 1417049628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA053509) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002286) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0003154) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-10-01 |