| NPI | 1508268707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057163) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OA003392) |
| 363A00000X Physician Assistant (Licence: VA 0110004917) | |
| 363A00000X Physician Assistant (Licence: MA057163) | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2020-07-06 |