| NPI | 1578529608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04838) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000025) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 25) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2015-07-14 |