| NPI | 1417291204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA238) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0001628) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110840690) | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2012-11-16 |