| NPI | 1508843681 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001158) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1477) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2017-05-01 |