| NPI | 1679578991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6356) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 1821) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2017-07-26 |