| NPI | 1487957668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 4121) |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2011-06-14 |