| NPI | 1669707295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL pa9107206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1086335) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2016-03-09 |