| NPI | 1639140361 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NC 0010-01507) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: IN 940096) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2010-01-19 |