| NPI | 1679807796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 073995) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1463) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2019-12-16 |