| NPI | 1528092301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9103447) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 00082) |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA400) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2012-07-10 |