| NPI | 1619114246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1416) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NE 1416) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2010-06-25 |