| NPI | 1578602017 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003585) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052848) |
| 363AM0700X Physician Assistant, Medical (Licence: DE c5-0000574) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2014-11-04 |