| NPI | 1568718534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056664) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004802) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2014-03-25 |