| NPI | 1710110465 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 0110004546) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-01912) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2016-01-27 |