| NPI | 1669577474 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 1645) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 2868) |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 2868) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-08-13 |