| NPI | 1629407945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1113) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5518) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2015-02-26 |