| NPI | 1619166212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.907) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01092) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2019-10-22 |