| NPI | 1528362159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MT MED-PAC-LIC-68538) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OR PA159424) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2019-08-29 |