| NPI | 1457510612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 943) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 12323) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2011-02-01 |