| NPI | 1417462763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA059551) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA004360) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2017-12-08 |