| NPI | 1528313749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1100) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA158770) |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2014-08-27 |