| NPI | 1598016701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MS PA00173) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.855) |
| 363AM0700X Physician Assistant Medical (Licence: AL PA855) | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2015-05-27 |