| NPI | 1417507260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2396) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 098001) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2019-09-13 |