| NPI | 1497057384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MT 636) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AZ 4784) |
| Enumeration Date | 2010-11-26 |
| Last Update Date | 2016-09-16 |