| NPI | 1457613523 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2431) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 006464) |
| 363A00000X Physician Assistant (Licence: VA 0110004199) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2016-05-16 |