| NPI | 1720167950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3834) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-530) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2010-07-13 |