| NPI | 1457352049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001539) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1401) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2020-12-03 |