| NPI | 1619153608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 001987) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005082) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2015-10-27 |