| NPI | 1649422403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC PA 1746) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA200212) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2015-12-16 |