| NPI | 1710901228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 41996) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 102037) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0001594) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-11-13 |