| NPI | 1700839834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0612) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001682) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-05-09 |