| NPI | 1508046475 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA001424L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001520) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2020-04-03 |