| NPI | 1629217385 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA2525) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA 2525) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2010-11-05 |