| NPI | 1457605214 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 20470) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 20470) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-12-20 |