| NPI | 1568572295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1138) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 003032) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-09 |