| NPI | 1558669986 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 2275) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA200351) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2013-08-15 |