| NPI | 1700931912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0201) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL Pa9107319) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2015-10-02 |