| NPI | 1609139021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1663) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NE 1663) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-07-13 |