| NPI | 1619087640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NC 102844) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102844) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-09-23 |