| NPI | 1699000638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054158) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03309) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2016-08-22 |