| NPI | 1528062239 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 635) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 001188) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2016-08-22 |