| NPI | 1700948312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005056) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA 1122) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2014-02-28 |