| NPI | 1548288129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA055695) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6022969-1206) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-09-12 |