| NPI | 1568460566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6935) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001249) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 001249) | |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 6935) | |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 6935) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2019-03-21 |