| NPI | 1508036518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03802) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 005266) |
| 363AM0700X Physician Assistant, Medical (Licence: SC 2435) | |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2019-03-19 |